| NPI | 1487886560 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: UT 11217957-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-808) |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2020-05-06 |